Prostate cancer spit test ‘brings national screening a step closer'

Telegraph

09-04-2025

A prostate cancer spit test has brought a national screening programme for the disease a step closer, experts have said.
The saliva test, which can be done at home, was proven to be more accurate at detecting prostate cancer than existing tests offered by the NHS in a breakthrough study published last year.
Their comments come a day after Wes Streeting, the Health Secretary, declared that he would like to see a screening programme for what is the most common cancer in men – if the decision was 'evidence-based'.
The UK National Screening Committee (NSC), which is responsible for such programmes, is examining the latest research.
The current prostate-specific antigen (PSA) test's tendency to over-diagnose patients who would have lived happily without needing treatment has meant that officials have resisted calls for a national screening programme.
But experts believe that the saliva test could be a screening option after the study showed it reduced the number of false positive results and picked up a higher proportion of aggressive cancers than the PSA test.
Naser Turabi, director of evidence and implementation at Cancer Research UK, said: 'Right now, there's no reliable method to detect aggressive prostate cancer, but this study brings us a step closer to finding the disease sooner in those people who need treatment.'
The spit test allows scientists to check a man's DNA for 130 genetic variants that have been linked to the cancer.
Its rollout could lead to fewer men being sent for unnecessary invasive procedures, better targeting those with aggressive forms of the disease at risk of spreading.
Researchers from the Institute of Cancer Research (ICR) in London and the Royal Marsden NHS Foundation Trust found the saliva test identified more men with prostate cancer and picked up more aggressive forms of the disease than the PSA test.
The PSA test is not routinely offered, but can be requested by men over age 50 from their GP. It is a blood test that detects the amount of a protein linked to cancer in the blood, however, its accuracy is a subject of controversy amongst scientists.
The research, published in the New England Journal of Medicine, used the spit test to assess 6,300 men aged 55 to 69 in Britain.
Some 468 men that the test deemed to be at high risk agreed to undergo a biopsy, of whom 40 per cent were diagnosed with prostate cancer.
This compares with 25 per cent of men with high PSA scores, who typically go on to be diagnosed with the disease.
The spit test also diagnosed a higher proportion of men with aggressive cancers that spread more quickly. They accounted for 55.1 per cent of the 187 diagnoses, compared with the 35.5 typically picked up by a PSA test.
Ros Eeles, a professor at the ICR and a consultant at the Royal Marsden, said the test could ' turn the tide on prostate cancer'.
'We have shown that a relatively simple, inexpensive spit test to identify men of European heritage at higher risk due to their genetic make-up is an effective tool to catch prostate cancer early,' she said.
'We can identify men at risk of aggressive cancers who need further tests and spare the men who are at lower risk from unnecessary treatments.'
Prof Kristian Helin, chief executive of the ICR, said there was an 'urgent need for a better screening test' and this study was 'a promising advancement towards that goal'.
Researchers have estimated that the spit test could identify up to 12,350 people earlier, saving the NHS about £500 million a year.
Asked about a potential new programme on Tuesday, Mr Streeting said. 'Decisions in this area do need to be evidence-based and evidence-led, and that's why we have a National Screening Committee. So I've asked the National Screening Committee to look at this, and they are.'
About 55,000 cases of prostate cancer are diagnosed each year in Britain, with 12,000 men dying.
A separate trial has been launched that will compare the saliva tests to the PSA test and an MRI scan.
Dr Matthew Hobbs, from Prostate Cancer UK, said that this next trial would 'test this genetic risk approach to make sure it worked at scale, and for men of all ethnicities'.
Prostate Cancer UK has called for guidelines to be changed so GPs can have discussions about getting tested with men at highest risk of the disease.
But other experts said that the ' evidence is not there yet ' to support a national screening programme.
'More research needed'
Jenny Donovan, professor of social medicine at Bristol University, said: 'The key criterion for screening from the National Screening Committee is that the benefit gained by individuals from the screening programme should outweigh any harms.
'We think the evidence shows that we're not there yet, and more research is needed.'
Freddie Hamdy, professor of urology at Oxford University, said the UK is 'not an outlier' by not having a screening programme – with only Lithuania and Mexico having schemes in place.
Prof Hamdy also said that because prostate cancer 'grows so slowly', previous studies have taken 20 years to report back.
Review the evidence
A Department of Health spokesman said: 'The National Screening Committee is reviewing evidence for prostate cancer screening programmes.
'Alongside £16 million investment into research, this Government's National Cancer Plan will transform the way we treat cancer and improve diagnosis, screening, treatment and prevention.
'Through a combination of investment and reform as part of the Government's Plan for Change, we will fix our health service and make it fit for the future.'